SFD (0008-195)79255 Mandarina
0008-195
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I'am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and.effect.
Liie # Lic. Class Exp. Date
L 6-QO645 B I -TIC A 00-0/2(
Date<'-- zJ-00 Signature of Contractor,
J
OWNER -BUILDER DECLARATION
I hereby affirm under penalty, of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code),
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section B&P.C, for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of.perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier INS, COMPANY 01; 7 Policy No. WDEM041000
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) :I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to. the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: G-/ /L /"Ad Applicant—,7-7e
• rl%, •+
ke.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set . forth on.,,his '
application.• ,
1. Each person upon whose behalf'this application is made & each person'at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of -La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) 4W _-t <<a Y-9 4 v Date
BUILDING PERMIT PERMIT#
/ %
DA,T.E / VALUATION LOT TRACT
CS /fit ; : 3,7411 J 7.4 2844'7>2
J / x.11✓
JOB SITE
ADDRESS 75).a-AIANDARJUA
APN
77 Dt U {1114
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
RXr Wvm_ *am, INC..
WT INVE-en 0-.9m, lac.
14251 UN1V'fj7RMTT DMVL,
1423 P_ XWV1,RXTY DidWt
PRt3WIX AZ $3034
PHGC11WM AZ 95034
(602)257.1656 Cf3IX 4990
USE OF PERMIT
tTF- bppMMpLWX2rl04I
S1q)- OT 24 P1,AN 30 -PERMIT I.1OES NOT INCL.UDZ HLdOCICWAL1S OR
POOL 16% PIAN CHECK P , E RIZOUCTION FOR 1+•9;ULTIPUK I ISUANCE OF:
SAME P A14 TYPE
CUSTOM CONSTRUCTION 210333N Sy
PORCH/PATIO - 130.00 sr
GARA.01 CARPORT (SF) 19,:ad.0p
t
RS '.li1 A9lED COST Or CONSWi1
2 y'7404%11
CONSTRUCTION FEY, ]W-00041t.Oo7 $15100,50
MAN CHECK FEE 101-000-433-318 $226.30
tJIk:CH:A,NICAL ME 101.000.421-000 $103.;00
KL ECT R1CAL, PR1: 101-000'420-000 $16(f.7a
PLAMBINO PFIE 101.000-419.000 X100. #0
ST1 ONO MOTION F ...EE • P.1.S1D 101-000-2.41-000 $33.37
ORA D140 FEE 101-000-423•000 $70.00
DEVE10PER IMPACT FEEM
ART IN PUBLIC PLACES - IiW,3r
; t 747'C7' Col` VT.P (!f10N AND P1 tel' CI' t;CE::,
$3,823.46
y E: Lr333 PRE -PAW FM
$0.00
TO1 'AL ITE 8 VON_ NOW
PP23Afi
RECEIPT
DATE
Bi-
DAT FINALEO
INSPECTOR ,
v
INSPECTION RECORD
iDPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
�2 — -7 -(,C/
Compressor
Insulation
- !�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final �! — - — j
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Waste Lines p2 16
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
(q - l /- C,o
Appliances
_
Final
Final , /
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
06/17/2002 10:13 7605646505
t 7
RJT HOMES
CITY OF LA QUINTA
( ' e , y BUILDING 8SAFETY DEPARTMENT
777-7012
INSPECTION REOUEST LINE
777-7153
Owner RJT HOMES LLC
Contractor RJT INVESTMENTS INC
0008-195
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
()INNS/9-255 19ANIJAMNA
PECT ORcR MUST SIGN ALL APPLICABLE SPACES
J k'A O "1` L4 PLAIN JJS F.t;KMl'l--V0ES NOT
INCLUDE BLOCKWAL.LS OR POOL
TYPE OF INSPECTION DATE INSP. v
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING _
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
D- NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING "-'--.. '
ROUGH GAS•& GAS TEST
HEATING &• ENI -•NC' /
FIREPLACE
ROOFBOND BEAM
BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING 6,0
INSULATION
PRE -ROOF
COVER- NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
r ' L GAS TEST
rING AIC
HOUSE NUMBERS
JOB COMPLETED.
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
PAGE 01